Information for Delaware Users

Welcome Delaware Providers!

The State of Delaware has created an initiative unique among US States--the ideal approach for detecting and addressing developmental-behavioral, social-emotion/mental health problems in young children. With legislative advocacy by Lieutenant Governor MattDenn, supported by the Delaware Academy of Medicine, the Delaware Chapter of the American Academy of Pediatrics, the Delaware Chapter of Family Practice, the Nemours Foundation, Delaware’s Autism Society, Speech-Hearing Association, the public library system, parents and professionals,Delaware’s Division of Public Health now offers free developmental-behavioral screening via PEDS Online for children residing in Delaware.

Not only does Delaware ensure that providers and parents have access to free, high quality screening, but the State also recognized that care coordination is essential. Care-coordination ensures that families actually receive recommended services. So on this page, we explain how the Delaware initiative works and provide information about the screening and referral process.

Enables families to complete screens prior to visits—so that clinicians are prepared for the encounter

Makes sure that clinicians can focus visits and spend time on parent education

Facilitates quality improvement initiatives

About the Screens within PEDS Online

PEDS Onlineis available for children 0 – 8 years of age and provides three screens:

1.1. Parents’ Evaluation of Developmental Status (PEDS),which involves 10 questions to parents’ eliciting their verbatim concerns. PEDS identifies which concerns are associated with high risk, moderate risk or low risk for developmental-behavioral/social-emotional/mental health problems. PEDS provides a focus for the visit (e.g., what types of referrals are needed, topics for parenting education. PEDS can be administered by interview for families who have reading difficulties.

2. PEDS: Developmental Milestones (PEDS:DM), which involves 6 – 8 questions about children’s skills in all developmental areas, including social-emotional. The PEDS:DM replaces the informal milestones on age-specific encounter forms with accurate items. The PEDS:DM can be administered by parent self-report, by interview, or hands-on by providers. The PEDS:DM helps confirm or disconfirm parents’ concerns and aids in decisions about whether parents need developmental promotion or whether a referral is needed.

3. The Modified Checklist of Autism in Toddlers (M-CHAT-R) is a narrow-band screen designed to detect possible autism spectrum disorders. The M-CHAT-R can be used with children 16 months of age through 3 years-11 months of age. The M-CHAT-R must be preceded by either PEDS and/or the PEDS:DM, because on its own, the M-CHAT-R will not detect other common problems (e.g., language-impairment, learning disabilities, cerebral palsy, intellectual deficits).

Information about Translations

PEDS is available in 45+ languages and each translation has been tested and proven to work. So if you use an interpretation service (e.g., phone-based translators), be sure they have the official translations. You can indicate which translations you need on your PEDS Online license agreement and we will send you digital files. Within PEDS Online, PEDS is presented in English and Spanish but Spanish-language comments will need to be back-translated into English before using the site. (PEDS is scored via sophisticated text-based scoring analyzer that searches for specific comments, in English, and then categorizes these by domains).

PEDS Onlinepresents PEDS:Developmental Milestones in English or Spanish. There is no need to back-translate. The PEDS:DM is also available in Portuguese, French-Canadian, Arabic, Chinese (Traditional), etc. You can request these files in your license agreement.

The Modified Checklist of Autism in Toddlers-Revised is presented in English or Spanish. There are numerous translations on the M-CHAT website and we will send you a link as part of your PEDS Online license agreement so that you can download the translations you need. Note that the MCHAT-R is now available but is not yet incorporated into PEDS Onlinebut will be once the Spanish translation is completed. We will keep you posted.

If you want families to complete screens before a visit, follow instructions below:

Clinician Referral Guidance

Delaware has designed a helpful flow chart to assist clinicians with referrals based on PEDS Online results. The chart provides guidance on where to refer families based on the child’s age and PEDS Online results. For example, some children need referrals to Child Development Watch or Child Find, while others are best helped by referrals to the Help Me Grow/2-1-1 Call Center.

You can ask parents to go to the PEDS Onlineparent portal before the visit to complete screens before the encounter. Parents will not see results. Instead an email alert will be sent to your clinic so that you can retrieve the results from your clinic’s unique database.

There are several ways to encourage parents to complete screens on their own:

Some clinics provide tablet computers in waiting or exam rooms and have parents use the portal while they wait.

Other clinics ask parents to complete PEDS Online at home before or after the visit. About 80% of families have access to a computer, either at home, through public libraries or public schools.

Delaware has created a brochure for parents that you can also downloadby clicking here. Be sure to insert your PEDS Online username and password, and then make photocopies to share with parents. You can also use the brochure as a reminder for the next appointment.

Using PEDS Online: Helpful Videos

Delaware Academy of Medicine created helpful videos about how to use PEDS Online.

Both documents ask parents for consent to share information from referral sources back to your office.

Other Implementation Suggestions

Probably the most challenging aspect of adopting quality approaches to screening/surveillance is figuring out how to make it work in our practices. There are many considerations but there are also many effective models.

Clinics implement PEDS Online in different ways –depending on staffing patterns, patient mix, and equipment. If you click here, you can read about the 5 different approaches to implementation.

You will also find a downloadable workflow planning guide/template to aid you in figuring out a viable step-by-step plan that works for your clinic. There is also an example of a clinic work-flow chart plus information about billing/coding for optimal reimbursement.

Training and Implementation Assistance

The Delaware Chapter of the American Academy of Pediatrics recruits and trains primary care practices to register for and implement the validated screening tool-PEDS Online in their practices during primary care well-child visits. The DEAAP Training and Technical Associate is available to provide PEDS Online training and technical assistance and to advise on office workflow, billing and coding, and the referral process.

For more information, contact the DEAAP Training and Technical Associate by email at: DEAAP.Trainer@medsocdel.org or by calling 302-224-5197.

Background Reading for Providers

Clinicians new to the use of accurate screening tools, often wonder why so many more patients are detected. Click here to open a documentthat describes prevalence, why accurate screens detect more children than do informal milestones checklists or ad-hoc questions to parents, to learn about American Academy of Pediatrics’ policy on early detection, research on the screens used within PEDS Online, including sensitivity, specificity and false-positives, and about findings from Delaware’s initiative.